1) Field of the Invention
In the context of this specification, a stent is a support structure, more or less tubular, for placement within a bodily lumen to support the tissue walls of the lumen. These stents usually require a delivery system to bring them to precisely the desired position within the body of the patient. This invention relates to stent delivery systems.
Two broad categories of stent can be identified. In one category, the stent is fitted around a sausage-shaped balloon, the balloon itself being on the distal end of a catheter. The catheter is advanced, for example, in the arterial system of the patient to the location where the stent is to be placed, and the balloon is then inflated to deform the stent plastically, expanding the stent radially against the wall of the bodily lumen. Since the deformation is plastic, the stent remains in its expanded disposition after deflation of the balloon, and the catheter and balloon system can then be withdrawn.
A second category of stent comprises stents which are self-expanding. For these stents, the delivery system employs some sort of sheath to constrain the stent in a radially small configuration. When the stent is in the desired location, the constraint radially outside the stent is withdrawn, allowing the stent to xe2x80x9cspringxe2x80x9d radially outwardly to press against the tissue wall of the lumen and permit withdrawal of the delivery system.
The present invention relates to a delivery system for a self-expanding stent. In this specification, the expression xe2x80x9cproximalxe2x80x9d relates to a point at the end of the delivery system held by the physician, and xe2x80x9cdistalxe2x80x9d to the opposite end.
2. Description of the Related Art
U.S. Pat. No. 5,645,559 (Hachtman et al.) discloses a delivery system for a radially self-expanding stent, the system having an inner tube around which the stent is fitted, and an outer tube that radially compresses the stent. FIGS. 5 to 8 of the drawings of US""559 shows progressive proximal withdrawal of the outer tube so as to release the self-expanding stent progressively along its length commencing with the distal end, and with the extreme proximal end of the stent being the last part of the stent to be released radially outwardly.
US""559 mentions the problem that during this release process there have been instances of axial travel of the stent relative to the delivery system, and not under the control of the surgeon or radiologist, so that the stent can end up in a position in the bodily lumen either proximal of or distal of, the desired location in the lumen. US""559 addresses this problem and proposes as a solution the addition of a relatively soft sleeve element which sits between the stent and the inner tube. This soft sleeve is required to exhibit on its radially outward surface a plurality of circumferential ribs. US""559 stresses that the ribs should be adjacent to the medial portion of the stent. Its FIG. 22 shows a bed 21 for the stent and what appear to be 14 ribs all in the central part of the length of the bed.
The present invention also addresses the problem of uncontrolled movement of a self-expanding stent relative to a stent delivery system, during the process of deploying the stent. The features which characterize the present invention are recited in claim 1 below. The dependent claims recite optional or preferred features.
The technical features of the present invention deliver an improved technical effect. The degree to which a self-expanding stent is gripped by a stent delivery system involves a judicious balance between different factors, and the present invention offers the possibility of a better balance, as follows.
Unwanted jumping of the stent out of the delivery system can be combated by providing a tight fit between the constraining surfaces inside and outside the stent. In other words, one can confine the stent in a very tight annular space, giving the stent minimal opportunity to spring out of the annular space prematurely. However, it is also important to ensure that, when release of the stent is desired, release can proceed smoothly. For this purpose, one would choose to have easy axial sliding between the constraining surfaces inside and outside the stent cylinder. In other words, it must be possible easily to proximally withdraw the outer constraining sheath. This factor points towards a loose fit of the sheath on the stent.
One insight which the present inventor has brought to this complex is the realization that the grip of the delivery system on the stent gets weaker as the sheath progressively withdraws since the area of sheath overlying the compressed part of the length of the stent is progressively shrinking. Thus, the likelihood of an uncontrolled spring of the stent away from the delivery system goes up in proportion to the amount of proximal withdrawal of the sheath. Thus, as long as the sheath grips tightly the proximal end of the stent in the last stages of stent release a looser grip on the distal end of the stent, in the early stages of release, is likely to be tolerable. If one assumes that resistance to proximal withdrawal of the sheath will be in proportion to the surface area of the sheath in sliding contact with the radially outside surface of the stent, then one can appreciate that the force required to pull the sheath proximally will tend to ease downwards, as the sheath progressively withdraws from the stent surface.
According to the present invention, pinch zones interact in the last stages of sheath withdrawal. This raises frictional resistance, but from a low level. The pinching effect enhances gripping of the stent when enhanced gripping is needed, however not before then.
With the invention, it will be noted, there is no interaction of the pinch zone on the sheath and the pinch zone on the catheter until after a majority of the length of the stent has already been released. Thus, the pinch zones do not materially add to the sliding resistance during release of the stent, until the last part of the release process. During this last part of the release process, the amount of sliding resistance is less than the frictional resistance at the start of the release process so that there is some scope for a tighter squeezing of the proximal end of the stent between two annular surfaces, without taking the frictional resistance back up to an unacceptably high level. Indeed, a judicious balance of materials and dimensions should enable a profiling of the frictional resistance so that the interaction between the first and second pinch zones compensates for the decline of frictional resistance with proximal movement of the sleeve, possibly leading to a more or less steady level of force needed for withdrawal of the sheath over the full length of the stent. Alternatively, the profile could be arranged to provide a signal, in terms of a characteristic tensile stress profile, delivered to the surgeon/radiologist that the second pinch zone has passed over the first pinch zone.
It is conventional in stent delivery systems to equip the delivery system with radioactive markers to enable radiologists to track the location of the distal end of the system. Often, the catheter is fitted with distal and proximal markers, of known disposition relative to the stent bed, and the constraining sheath also has a marker so that the degree of withdrawal of the sheath, relative to the stent bed, can also be tracked. Conveniently, these radioactive markers are thin metal bands crimped or swaged onto the outside surface of a polymeric tubular element. In one preferred embodiment of the present invention, such a metal radioactive marker band is fitted around the sheath at its distal end, and squeezed into the outside wall of the sheath by an amount calculated to displace the sheath wall, inside the marker band just enough to create the second pinch zone.
One convenient way to create the first pinch zone is by depositing on the cylindrical wall of a tube of the catheter an annulus of cured polymeric adhesive. Preferably, a metal radioactive marker band can be set within the same adhesive deposit, thereby to form the proximal end of the stent bed.